The Ins & Outs: Pacing for Pain Management

Pacing for Pain Management (It’s All About the Pace, ‘Bout the Pace, ‘Bout the Pace).

Do you remember the classic Aesop fable from your kiddie years, ‘The Tortoise and the Hare?’

Who do you most relate to: Slow and Steady (Tortoise) or Fast-As-Lightening (Hare)?

I’ve always identified more with the Hare. My fall-back pace in life is FAST.

My brain and body are usually at odds with each other, battling it out for the driver’s seat.

Let’s call it a power struggle between the Tortoise (body) and the Hare (brain):

  • Brain says go fast!
  • Body says Whoa(!) there young grasshopper! Let’s pace ourselves!

My brain used to win the argument A LOT. I would listen to my brain, push my body, and surprise, surprise, flare-up my pain levels and dive-bomb my energy. The old ‘boom and bust’ pain cycle was on a continuous loop:

Feeling better so I’ll make up for lost time and do more today…Whoops, over did it!….Pain goes BOOM!…Crashing out; extended recovery period…reset the clock and repeat the cycle…

After one too many ‘this shiz isn’t working for me!’ moments (I’m a tad stubborn!), the pendulum has swung more in favour of listening to my body.

The Tortoise is taking over.

It’s all about the pace.

  • Do you suffer from chronic pain?
  • Are you limited in your activities?
  • Do you push yourself hard and make your pain worse?
  • Do you enter the ‘boom and bust’ cycle with regularity?

{In my best Radio Announcer’s Voice}:

THEN PACING FOR PAIN MANAGEMENT MAY BE THE SOLUTION FOR YOU!

Pacing for Pain Management – What it IS:

  • Building activity tolerance up SLOWLY, at a rate your body can accept, using measurement (time, distance, counting) to tell you when to stop. The idea is to avoid the ‘boom and bust’ cycle of pain management by taking a rest BEFORE pain forces you to stop, and by breaking down activities into more manageable chunks over a delayed time period.

Example: Instead of rushing around and cleaning the house for 3 consecutive hours (not that I do this, that’s what Hubby is for!), pacing means you would spread the tasks over a longer period, say 3 days, to try to avoid the flare up.

  • The potential key to help you control your pain rather than the pain controlling you:

Reduced # of Pain Flares = Less Pain Killers + Less Downtime

= More productive (and HAPPIER, cos hey, less pain!)

  • Extremely frustrating!

Pacing for Pain Management – What it’s NOT:

  • Easy!
  • Pushing through or into the pain barrier.
  • Pushing until you crash and then deciding to ‘pace.’
  • Letting pain be the guide as to when we start or stop activities.

Pacing has been a hard lesson for me to learn.

I’ve really only warmed to the concept over the past 18 months.

{4 years ago}

Pain Clinic Specialists: Bree, you’ve got to start pacing to control your pain flare ups.

Me: What does that involve?

Pain Clinic Specialists: You have to go back to baseline activitiesblah blah blahstop before you feel a spike in pain and restblah blah blah…pace it up in increments of 10% per week for each activity…

{After doing some quick mental gymnastics and concluding that walking without pain for 30 seconds equated to a 3 second incremental change per week}

Me: WTF?!! Then I won’t do ANYTHING! I won’t even make it from my bed to the toilet at this rate! This pacing theory is s*#%!

Pain Clinic Specialists: This is where we are at. This is your state of play. Thou shalt pace!

{Ok, they didn’t really go all Shakespearean on me, but you get the picture!}

It’s fair to say I was a tad, err, resistant to this particular therapy.

What stops you from pacing?

If you google ‘pacing for pain management’ or similar terminology, you will find pages of articles dedicated to this ‘critical’ skill that all pain patients should wholeheartedly embrace.

Not much is covered by way of pacing challenges.

Here are some of my top contenders. Perhaps you can relate to some of these?

How pacing is marketed as a treatment option.

Question: When are you more likely to be open to new possibilities?

Option A: When you feel empowered, informed and your opinions valued?

OR

Option B: When you are scared into submission through a combination of fear, guilt and ‘we-know-best’ tactics?

Ooh, ooh, Option A!

Pity that wasn’t how my introduction to pacing went down.

I was told in no uncertain terms that I had to pace if I wanted to get better.

Handed a pile of information and told to go away, read it and apply it.

Berated when I raised objections. Fears dismissed as trivialities.

The air was heavy with insinuation: Here was a workable solution and I was putting up barriers.

I mustn’t want to help myself.

Option A would have worked so much better.

Me, myself and I.

It has been easier to adopt the attitude that my body hurts anyway, even when resting, so why not throw caution to the wind and just go for it?

Practicality of application vs. quality of life.

I was vehemently opposed to the 10% incremental rises per activity per week as advocated by my doctors.

When your functionality is at such low levels that the necessities of life can push you beyond your pacing limits, the whole idea seems completely unachievable.

My outburst about the bed-to-bathroom scenario was not an exaggeration. If I worked to the letter of the Pacing Law, understanding that I live with full-body chronic nerve pain, at my worst, I would have been virtually bed-bound.

Imagine this:

  •         15 seconds into typing…aaaandd… gotta stop now!
  •         Washing my hair, arms start burning…aaaanddd… gotta stop now!

Never underestimate the mental and emotional element of pacing.

When I tried to picture how my life would be like if I paced, all I could see was a long, dark and lonely road ahead of me.

Stripped of all my hard-fought independence, quality of life and happiness.

Limitations laid bare.

Expected to give up everything in the short-term for the allure, but no guarantee, of a long-term improvement.

Yeah, thanks but no thanks!

Frustration over the tediousness of the approach.

The truth has to come out: Pacing is BORING!

The lack of spontaneity and the need to be organised about the most basic daily activities incites the rebel within.

Common sense flies out the window.

Even the threat of a prolonged pain relapse isn’t enough to thwart our attempts to do something, anything, beyond the confines of a pace-controlled world.

So we intentionally exceed our limits.

Sometimes we get away with it. Usually we don’t.

It takes too damn long to do anything!

Stopping to take constant rest breaks left me thinking that I would never get anything done. Everything seems to take two, three, four times as long as it should.

Therefore, Pacing + Bree = at loggerheads for the longest time

What I failed to appreciate is when the activity time is added to the recovery time (necessitated by increased levels of pain), the total elapsed time is often longer than the pace-breaks.

Example: Cooking dinner for 30 minutes

Possible scenario without pacing:

30 minutes of cooking followed by 1* hour to manage a pain flare. Total time = 1.5 hours with pain flare-up.

*This number is extremely conservative. Pain flares can last for hours, even days, if we push the envelope too much.

Possible scenario with pacing:

5 minutes of cooking followed by a 10 minute break, repeated 6 times. Total time = 1.5 hours with a minimised or zero pain flare-up.

Finding the exact amount of activity you can do without causing a flare-up of symptoms is an art form.

My technique still requires some work!

How to move forward, and not fall behind, when we can’t do too much?

Pacing is an art, not a science, so creative license is very much allowed!

There is a profound sense of relief in knowing that I don’t need to adhere to the restrictive pacing guidelines to see an improvement.

I can take the underlying concepts and adapt it to my lifestyle and my needs.

This means:

  •         Paying attention to what my body is telling me and taking corrective action as required.
  •         Wearing my pedometer each day to make me more conscious of my physical activity (just in case I slip and ignore thy body!) and any associated pain patterns or triggers.
  •         Being open to performing activities in new ways to find what works for me.
  •         Taking note of what pushes me to over-stretch myself some days.
  •         Taking regular breaks.
  •         Prioritising daily self-care.
  •         Reminding myself (call it self-permission) that everything doesn’t have to be done, like, yesterday! And nor do I necessarily have to be the person to do it.
  •         Letting myself off the hook: There will be days when I make a calculated decision to intentionally exceed my limits to do something that is important to me. And that is ok.

It’s all about the Pace…And Slow and Steady Wins the Race!

Time for the Hare to take a bit of a sabbatical!

Now it’s your turn! Do you use pacing to manage your chronic pain? Let me know in the comments below.

Tortoise signing out,

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All photos the property of Starbrite Warrior and Bree Hogan

6 Replies to “The Ins & Outs: Pacing for Pain Management”

  1. “My days are backwards…I wake up tired and go to bed wide awake.” I so know this feeling. I too am struggling with the whole pacing thing. I am improving and I regularly give myself days off. But then I feel so guilty about taking a day out the old Hare reappears! Currently, the house is a mess, what with Christmas (no decs for me this year) and NY… which were both great, spending them with my daughter and son-in-law and my new grandson. Unfortunately, my daughter has inherited my condition and she is now in a big slump (hubby is in the Navy and gone back to his ship). We spoke earlier today and I told her we both need the day off (although she has a 6 month old baby, so it’s a relative term – oops,no pun intended 🙂 ). We have a plan for the week coming to help each other with the tidy up. I’m definitely going to get her to sign up to Starbrite Warrior too. Thank you so much.

    1. It’s definitely a fine balance with that ‘ol Hare/Tortoise, Shona, and it can be so easy to tip the scales in the wrong direction! But that’s all part of the learning, the journey. I’m a lot better at it now but I still need the odd reminder when I let my brain take over and my poor body is struggling to keep up! I hope that you and your daughter take the downtime that you desperately need – and that bubba cooperates and goes along with it, at least as much as babies are able to! I’m so glad you found my site and I look forward to chatting with you more. (hugs) Bree xx

  2. Bree, this is such a great article. It is extremely difficult for me to pace, as even the tiniest movements can throw me into a flare. Lately, lack of sleep has been my enemy and I’m not able to even rest without pain. Not to mention any other daily tasks (I.e. Walking to the bathroom, brushing my teeth, even eating!!). But once the painsomnia wears off, I am going to definitely implement your ideas abt pacing. If I can become a better listener to my body, it will go loads better for me!! Thanks so much for sharing…I love ur blog! ?

    1. I hear ya Christina, pacing is soooo hard to put into practice because it feels really restrictive and like you say, even the littlest of things can cause a pain spike, so then what are you supposed to do? Traditional pacing rules advocate that we stop completely as soon as pain spikes but that isn’t always practical/logical/realistic. Gah! It’s taken me ages to work out a balance that seems (for the most part) to work for me. You will get there 🙂 I’m so sorry to hear that your body has been flaring on you of late, damn that painsomnia! I’m reminded of a quote I keep seeing on FB which is so appropriate for those of us that battle with the nights: “My days are backwards…I wake up tired and go to bed wide awake.” Pain, restless legs, all that other fun stuff that makes sleep elusive. Hang in there lovely. Xx

  3. Hi Bree,
    Good food for thought here. I used pacing all the time before my recent good spell. In truth, I still do pace now I am feeling so much better, but not as well. It’s like I’ve been given an inch so I take a mile! The stubborn is strong in me, too!
    Pacing is so frustrating at first, but after years of building the habit there comes a kind of acceptance. Even my family got used to the paced progress and were a bit shocked when things improved. I think it can be quite a zen place to be, pacing. If you let it.
    Thanks for your piece!

    1. Hi Rach,
      Thanks for your insights and for taking the time to leave a comment. 🙂

      I think you are right about the whole acceptance thing – once I realised that I could pace in a way that worked for me (begone, 10% increments!) it became a lot easier to take on board and apply. But like you, I just have to watch the whole ‘give an inch, take a mile’ stubborn streak!

      My natural inclination is to be the Hare, which is very much why I struggled with the whole idea for such a long time, but I’m coming around to the fact that the Tortoise is pretty cool too. That’s the zen talking! Xx

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